Prevention of Recurrent Benign Paroxysmal Positional Vertigo: The Role of Combined Supplementation with Vitamin D and Antioxidants.

Benign paroxysmal positional vertigo (BPPV) usually has a favorable course, although it is possible to observe BPPV with a high recurrence rate. Previous studies suggested that vitamin D deficiency might affect BPPV recurrences, and oxidative stress might play a complementary role in BPPV pathogenesis. This multicentric trial aimed to evaluate the effectiveness of oral nutritional supplementation with a compound of alpha-lipoic acid, Carnosine, and Zinc (LICA® (Difass International, Coriano (RN), Italy)), vitamins of group B and vitamin D in preventing BPPV recurrences. A total of 128 patients with high recurrence-BPPV were randomized in three arms: Arm 1 consisted of subjects with "insufficient" or "deficient" vitamin D blood levels, treated with daily oral supplementation of LICA®, vitamins of group B and vitamin D3 (800 UI), Arm 2 included BPPV subjects with "sufficient" vitamin D who did not receive any nutritional support, and Arm 3 included subjects with a "sufficient" serum concentration of vitamin D who received supplementation with a compound of LICA® and Curcumin. After six months of follow-up, a significant reduction of BPPV relapses compared to the baseline was found only in Arm 1 (−2.32, 95% CI: 3.41−1.62, p-value < 0.0001). Study results suggested that oral nutritional supplementation with vitamin D3 plus antioxidants can prevent relapses in patients suffering from high recurrence-BPPV.

The Navigation Ability Test (NAT 2.0): From Football Player Performance to Balance Rehabilitation in Chronic Unilateral Vestibular Loss.

AIM OF THE STUDY: in humans, spatial orientation consists of the ability to move around the environment through memorized and pre-programmed movements, according to the afferent sensory information of the body and environmental analysis of the Central Nervous System (CNS). The purpose of this study is to analyze the abilities of professional athletes, such as footballers, to use mental navigation systems, cognitive maps, and memorized motor patterns in order to obtain better physical performance and to obtain useful information for training both non-sports subjects and vestibular patients for rehabilitation purposes. MATERIALS AND METHODS: all the motor performances of sportsmen, healthy non-sporting subjects, or vestibular patients are based on the acquisition of visual-spatial and training information. In this study, we analyzed the visual-spatial performance of 60 trained sportsmen (professional footballers), 60 healthy non-sports subjects, and 48 patients affected by chronic unilateral vestibular loss by means of the Navigation Ability Test 2.0. A score based on the number of targets correctly reached in the various tests quantifies the degree of performance of the subjects. RESULTS: NAT 2.0 scores progressively improve from vestibular subjects to healthy non-sporting subjects to footballers. NAT 2.0 scores improve in all three subject groups as the number of tasks performed in all patient groups increases, regardless of gender and age. CONCLUSIONS: the analysis of performance data through NAT 2.0 in athletes (footballers) opens new perspectives for rehabilitation purposes, regardless of age, sex, and training conditions, both in healthy non-sporting subjects to improve their sporting potential and in patients affected by chronic vestibular dysfunction, in order to optimize their motor skills and prevent falls.

Harmonic Scalpel vs "cold knife" dissection in uvulopalatopharyngoplasty.

PURPOSE: The aim of this study has been to compare the Harmonic Scalpel (HS) and the "cold knife" dissection in the treatment of snoring by uvulopalatopharyngoplasty (UPPP). MATERIALS AND METHODS: The investigation included 40 adult males with snoring. Patients were assigned to two homogeneous groups (A and B) and UPPP was performed using HS or "cold knife" dissection in groups A and B, respectively. Before and 6 months after surgery, each patient was studied using the apnea-hypopnea index and a visual analogue scale of snore levels. Postoperative assessment of pain was evaluated on postoperative days 1 and 10. All the patients underwent to a perioperative evaluation concerning the duration of surgical dissection, the amount of intraoperative blood loss and days of hospitalization. RESULTS: In group A, the HS provided excellent control without side effects on the adjacent structures and postoperative complications. Harmonic Scalpel's group experienced shorter operation time, lesser blood loss, fewer days of hospitalization and lower postoperative pain. CONCLUSIONS: The use of the HS in UPPP is safe and confers some advantages over conventional methods of UPPP: its use led to diminished bleeding, shorter operation time, lesser pain, and better wound healing in the postoperative period.

Effects of uvulopalatopharyngoplasty with Harmonic Scalpel on speech and voice.

The aim of this study was to evaluate changes in acoustic features of speech and voice after uvulopalatopharyngoplasty (UPPP) with the Harmonic Scalpel (HS), using the multidimensional voice program (MDVP) in conjunction with other tests. Before and 6 months after surgery, phonetically balanced sentences and sustained vowels a, e, i were carried out and digitalized with MDVP in all the patients, as an evaluation of nasal resonance (trough the Glatzel and the Gutzmann tests), speech articulation and voice handicap index (VHI). These parameters were estimated: average of fundamental frequency, Jitter, Shimmer, noise-to-harmonics ratio, voice turbulence index, soft phonation index, degree of voiceless, degree of voice breaks and peak amplitude variation. Six months after surgery, improvements in all the acoustic parameters, in nasalance and VHI were achieved. In our experiences UPPP, with the HS, improves speech and voice in patients affected by snoring and/or obstructive sleep apnea syndrome.

New trends in head and neck surgery: a prospective evaluation of the Harmonic Scalpel.

BACKGROUND: The use of ultrasonic technology to cut and coagulate tissues with minimal tissue damage has been investigated in general surgery and gynecology. The purpose of this study was to verify the efficacy and applicability of the Harmonic Scalpel in head and neck surgery. MATERIAL/METHODS: A non-randomized study was undertaken on 40 pharyngolaryngectomies, 40 total laryngectomies, 40 radical neck dissections, and 40 superficial parotidectomies performed using the Harmonic Scalpel (80 patients) or "cold knife" dissection (80 patients). The evaluation included operation time, intraoperative blood loss, quantity of neck drainage on the first and second postoperative days, postoperative seroma formation, pattern of wound healing, days of hospitalization, and subjective assessment of postoperative pain. RESULTS: In patients treated with the Harmonic Scalpel, the mean operation time was significantly (p<0.05) shorter (119.1+/-1.35 vs. 156.9+/-1.51), intraoperative blood loss (121.5+/-1.28 vs. 257.5+/-2.32) and the quantity of neck drainage on the first (47+/-0.87 vs. 89+/-1.28) and second (38.7+/-0.86 vs. 75.5+/-1.34) postoperative days were significantly less, and the days of hospitalization (6.67+/-0.48 vs. 8.8+/-0.58) and the pain scores (3.24+/-0.63 vs. 5.91+/-0.83) were significantly lower than in the "cold knife" group. No postoperative complications were noted in the Harmonic Scalpel group. CONCLUSIONS: The use of the Harmonic Scalpel in head and neck surgery is safe and confers some advantages over conventional methods of head and neck dissection.

Harmonic scalpel in pharyngolaryngectomy with radical neck dissection.

OBJECTIVE: The aim of this study was to verify the efficacy and applicability of the Ultracision Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH) in pharyngolaryngectomy with radical neck dissection. DESIGN: This work evaluated the use of the Harmonic Scalpel in otolaryngology as a new and alternative method to overcome some complications of traditional surgery. SETTING: The study was conducted with 20 patients in the ENT Department of the University of Genoa (Italy) between January 1, 2005, and December 31, 2006. METHODS: A prospective, randomized study was undertaken on 20 pharyngolaryngectomies with radical neck dissection performed using a Harmonic Scalpel (10 patients) or traditional surgery (10 patients). MAIN OUTCOME MEASURES: The evaluation included operation time, intraoperative blood loss, postoperative seroma formation, and pattern of wound healing. RESULTS: In patients treated with Harmonic Scalpel, the mean operation time was significantly shorter, the blood loss was less, laryngeal and neck drainage on the first and second postoperative days was significantly smaller, and no postoperative complications were noted. CONCLUSIONS: The use of the Harmonic Scalpel during pharyngolaryngectomy and radical neck dissection led to diminished bleeding, shorter operative time, less seroma formation, and better wound healing in the postoperative period.